Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement.

Steven L. Gortmaker (sgortmak@hsph.harvard.edu) is a professor of the practice of health sociology at the Harvard T.H. Chan School of Public Health, in Boston, Massachusetts.

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Y. Claire Wang is an associate professor at the Mailman School of Public Health, Columbia University, in New York City.

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Michael W. Long is an assistant professor at the Milken Institute School of Public Health, the George Washington University, in Washington, DC.

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Catherine M. Giles is a program manager at the Harvard T.H. Chan School of Public Health.

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Zachary J. Ward is a programmer analyst at the Harvard T.H. Chan School of Public Health.

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Jessica L. Barrett is a research assistant IV at the Harvard T.H. Chan School of Public Health.

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Erica L. Kenney is a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health.

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Kendrin R. Sonneville is an assistant professor at the University of Michigan School of Public Health, in Ann Arbor.

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Amna Sadaf Afzal is an assistant professor at the Albert Einstein College of Medicine, in New York City.

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Stephen C. Resch is deputy director of the Center for Health Decision Science at the Harvard T.H. Chan School of Public Health.

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Angie L. Cradock is a senior research scientist at the Harvard T.H. Chan School of Public Health.

Abstract

Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. We estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery. We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015-25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals. In our model, three of the seven interventions--excise tax, elimination of the tax deduction, and nutrition standards for food and beverages sold in schools outside of meals--saved more in health care costs than they cost to implement. Each of the three interventions prevented 129,000-576,000 cases of childhood obesity in 2025. Adolescent bariatric surgery had a negligible impact on obesity prevalence. Our results highlight the importance of primary prevention for policy makers aiming to reduce childhood obesity.